HomeMy WebLinkAboutBuilding Permit Application i
!ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: Z \\t%-d���
RECEIVED
[LUCE ` MAY 0 4 2021
Pmittung Department
Building Permit Application St.w rude Count.
Planning and Development Services
Building and Code Regulation Division Commercial Residential i!
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROP,.OSED IIVIPROUEMENT LQCAI'ION
Address: 15!� LD6W r EA
Property Tax ID#: 3>41 q - 5 00- D02.1- wo- I Lot No.to
Site Plan Name: Kivu Park LAn(f -f ?n rt Block No.
Project Name:
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;DETAILED DESCRIPTION OF WORK ,
New Electrical Meter Second Electrical Meter
CONSTRUCTION-I,NFORMATI.ON. ... ,
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator -** Roof Pitch
Total Sq. Ft of Construction: aaOo 151 Sq. Ft. of First Floor:
Cost of Construction:$ 13)-nb Utilities: —Sewer _Septic Building Height:
I
CI WN'ER/LESSEE ;CONTRACTOR. r
Name aka Name: rolvin L EEMMM
Address: Company:
City: 11ri SJFpp�� State: Address: � Nt B2P Tt Ijnn a�Zip Code: qb F/�a x: City:��YIS-P 1') P�C'.h Stater,
Phone No.TZ ( 21 nQ2 Zip Code: Fax:
E-Mail: Phone No - - 'S
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
,?
�LENiENTALCONSTRUCT10N LIE LAIN INF
4NER/ENGINEER: _Not Applicable MORTGAGE COMPANY:' _ Not Applicable
he
Name:
,,,,"Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
i
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I�certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
i i n accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
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4-7",-1--7
Signature f Owner/Lessee/Contractor as A ent for Owner Signa ure of Contractor icense Holder
STATE OF FLORIDA STATE OF FLO IDA
UJ
COUNTY OF -� (A COUNTY OF ikh V1
Sworn to(or affirmed)and subscribed before me of Sworn o(or affirmed)and subscribed before me of
- ✓Ph sical Presence or Online Notarization Physical Presence or Online Notarization
this day of ftQY(,Z-1 ,, 020 by this 2-1 day of by
Name of person making statement. I
Name of person making statement.
Personally Known OR Produced\�{BD I t�bo,� Personally Known ✓ OR Produced Identificatic umig,,
Type of Identification \��` N FF �i,� Type of Identification ��� O P M 1 F ,
Pr duced .`� oinM19 oNF yy''�� Produced \�.`��Q�• �asioti' y
�G O�
:Z NOTARY �N': - — � > t4OTARY
(Signature of Notary Public-State of FloridaF u B L I C = (Signature of Notary Public-State of Florida J C _=
50�� 91 C'�PUBL
Commission No. % GG2%p Q Commission No. Se�J MM.M G G'g
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FLO ��`� OF
REVIEWS F�O��•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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